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Novel Triple-Loop Technique for Suturing TFCC Injuries without Transosseous Tunnel
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Predictors for poor outcome for conservatively treated traumatic triangular fibrocartilage complex tears.

Ji-Yang Xiao1, Bo Liu1, Lily Li2

  • 1Department of Hand Surgery, Beijing Ji Shui Tan Hospital, The Fourth Clinical College of Peking University, Beijing, China.

The Bone & Joint Journal
|August 2, 2021
PubMed
Summary

Above-elbow immobilization is a viable nonoperative treatment for traumatic triangular fibrocartilage complex (TFCC) tears, especially without distal radioulnar joint (DRUJ) subluxation. Short-arm splints and DRUJ subluxation predict poor outcomes.

Keywords:
Conservative treatmentDRUJ subluxationImmobilizationRisk factorsTraumatic TFCC injuryUlnar variance

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Area of Science:

  • Orthopedic surgery
  • Sports medicine
  • Hand and wrist surgery

Background:

  • Traumatic triangular fibrocartilage complex (TFCC) tears often require effective nonoperative management.
  • Identifying predictors of poor outcomes in TFCC injuries is crucial for guiding treatment decisions.

Purpose of the Study:

  • To evaluate the efficacy of immobilization alone for traumatic TFCC tears.
  • To identify clinical factors predicting poor prognosis in patients with TFCC injuries.

Main Methods:

  • Retrospective analysis of 89 wrists in 88 patients treated with short-arm or above-elbow splints for six weeks.
  • Outcome assessment using visual analogue scale for pain, Patient-Rated Wrist Evaluation, Disabilities of the Arm, Shoulder and Hand score, and modified Mayo Wrist Score (MMWS).
  • Logistic regression analysis to identify independent predictors of poor outcomes (MMWS < 80 or surgical intervention).

Main Results:

  • Good outcomes were achieved in 76% of wrists treated with above-elbow splints versus 29% with short-arm splints (p < 0.001).
  • Complete foveal TFCC tears and dorsally subluxated distal radioulnar joint (DRUJ) were associated with poor outcomes on univariate analysis.
  • Short-arm immobilization and DRUJ subluxation independently predicted poor outcomes in logistic regression analysis.

Conclusions:

  • Nonoperative management with above-elbow immobilization is a viable treatment for traumatic TFCC injuries, particularly when DRUJ subluxation is absent.
  • Early surgical consideration is recommended for patients with dorsal ulnar subluxation treated with short-arm splints to mitigate prolonged morbidity.
  • DRUJ subluxation and short-arm splinting are significant predictors of poor outcomes in traumatic TFCC tears.